Korelacija nedovoljne koncentracije vitamina D i sekundarnog hiperparatireoidizma kod žena sa prelomima na malu traumu
Sažetak
Uvod/Cilj. Osteoporoza je metabolička bolest kostiju koju karakteriše smanjenje koštane čvrstine, posebno kod žena nakon menopauze. Danas, više od 25 miliona ljudi pati od ovog metaboličkog poremećaja. Pored genetske predispozicije, hormonski poremećaj, način života i nedovoljna koncentracija vitamina D u krvi su značajan faktor rizika za pojavu osteoporoze i preloma na malu traumu. Cilj naše studije bio je da ispitamo učestalost osteoporoze, kao i vezu između deficita vitamina D u krvi i hiperparatireoidizma kod žena različite životne dobi koje su imale prelom na malu traumu. Metode. U studiju preseka bilo je uključeno 559 žena koje prethodno nisu bile lečene od osteoporoze. Sve žene bile su klinički pregledane i od svih je uzeta anamneza o hroničnim bolestima, prelomima i prethodno uzimanoj terapiji. Svakoj ispitanici izmerene su masa i visina, izračunat je indeks telesne mase (ITM) i uzeta je krv za laboratorijske analize. Analizirani su faktori rizika za osteoporozu, uključujući koncentraciju 25-hidroksi vitamina D [25(OH)D] i paratireoidnog hormona. Snižena koncentracija vitamina D definisana je kao serumska koncentracija 25(OH)D manja od 30 ng/mL (75 nmol/L). Rezultati. Studija je
obuhvatila 559 žena, od kojih su 102 imale prelome na malu traumu. Žene koje su imale prelom bile su starije (63,69 ± 13,88 godina) u poređenju sa ženama bez preloma (54,39 ± 14,10 godina) (p < 0,0005). Indeks telesne mase bio je veći kod žena sa prelomima (26,49 kg/m2) u poređenju sa drugom grupom (24,79 kg/m2) (p < 0,025). Od 102 žene sa prelomom, 88 je bilo u menopauzi. Ispitanice su najčešće imale prelom distalne podlaktice i proksimalne nadlaktice, 11,62% (65/559), zatim prelom vrata butne kosti, 7,15% (40/559) i prelom tela pršljena, 3,04% (17/559). Značajno niže vrednosti mineralne koštane gustine na kičmi i vratu butne kosti zapažene su kod žena sa prelomom vrata butne kosti i tela pršljena, ali ne i kod žena sa prelomom nadlaktice i podlaktice. Snižene koncentracije vitamina D nisu pokazale statistički podržanu značajnost kod žena sa prelomom. Povišena koncentracija paratireoidnog hormona (> 65 pg/mL) pokazala se statistički značajnom kod žena sa prelomom vrata butne kosti i tela pršljena. Zaključak. Kod žena koje su imale prelom kosti na malu traumu, na sve tri lokalizacije, u poređenju sa ženama bez preloma, značajni faktori rizika za osteoporozu su godine života, mineralna koštana gustina i jačina mehaničke snage tokom pada (procenjena preko indeksa telesne mase).
Reference
Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 1993; 94(6): 646‒50.
Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, et al. Fracture Intervention Trial. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin En-docrinol Metab 2000; 85(11): 4118‒24.
Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures. Osteoporos Int 2000; 11(7): 556‒61.
Ström O, Borgström F, Kanis JA, Compston J, Cooper C, McCloskey EV, et al. Osteoporosis: burden, health care provision and opportunities in the EU. A raport prepared in colaboration with the international Osteoporosis Foundation (IOF) and the European Federation of pharmaceutical Industry Association (EFPIA). Arch Osteoporos 2011; 6: 59‒155.
Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A. Risk of hip fracture according to the World Health Organiza-tion criteria for osteopenia and osteoporosis. Bone 2000; 27(5): 585‒90.
Eastell R. Management of bone health in postmenopausal women. Horm Res 2005; 64 Suppl 2: 76‒80.
Kanis JA, Compston J, Cooper C, Hernlund E, Ivergard M, Johans-son H, et al. The burden of fractures in the European Union in 2010. Ostoporos Int 2012; 23 (Suppl 2): S57.
Borissova AM, Shinkov A, Vlahov J. Epidemiology of osteopo-rosis, fractures and vitamin D deficiency in bulgarien women aged 50 years and older. In: Abstracts of the IOF World Con-gress on Osteoporosis & 10th European Congress on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. May 5-8, 2010. Florence, Italy. Osteoporos Int 2010; 21 Suppl 1: S1‒399.
Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE. Practice pat-terns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 2004; 15(10): 767‒78.
Saridogan M, Akarirmak U. Correlation of vitamin D and bone mineral densitiy in postmenopausal women. In: Abstracts of the IOF World Congress on Osteoporosis and 10th European Congress on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. May 5-8, 2010. Florence, Italy. Osteopo-ros Int 2010; 21 Suppl 1: S1‒399.
Kanis J, Borgsrom F, De Laet C, Johansson H, Johnell O, Jonsson B, et al. Assessment of fracture risk. Osteoporos Int 2005; 16(6): 581‒9.
Kanis JA, Oden A, Johnell O, De Leat C, Jonsson B, Oglesby AK. The components of excess mortality after hip fracture. Bone 2003; 32(5): 468‒73.
World Health Organization. Assessment of osteoporosis at the primary healthcare level. Summary Report of a WHO Scien-tific Group. Geneva: WHO; 2007. Available from: www.who.int/chp/topics/rheumatic/en/index.html
Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994; 843: 1‒129.
Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res 1994; 9(8): 1137‒41.
Khluood SH, Al Kadi H, Lanham-New S. Extent of obesity in saudi women and the association between vitamin D sta-tus and different measures of adiposity. In Abstracts of the IOF World Congress on Osteoporosis & 10th European Con-gress on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. May 5-8, 2010. Florence, Italy. Osteoporos Int 2010; 21 Suppl 1: S1‒399.
Kaze AD, Rosen HN, Paik JM. A meta-analysis of the associa-tion between body mass index and risk of vertebral fracture. Osteoporos Int 2018; 29(1): 31‒9.
Compston JE, Flahive J, Hosmer DW, Watts NB, Siris ES, Sil-verman S, et al. Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW). J Bone Miner Res 2014; 29(2): 487‒93.
Milenkovic S, Aleksic I, Dimic A. The correlation between vita-min D status and frequency of vertebral osteoporotic fractures in women with postmenopausal. In Abstracts of the IOF World Congress on Osteoporosis & 10th European Congress on Clinical and Economic Aspects of Osteoporosis and Oste-oarthritis. May 5-8, 2010. Florence, Italy. Osteoporos Int 2010; 21 Suppl 1: S1‒399.
Lopes JB, Danilevicius CF, Takayama L, Caparbo VF, Scazufca M, Bonfá E, et al. Vitamin D insufficiency: a risk factor to ver-tebral fractures in community-dwelling elderly women. Ma-turitas 2009; 64(4): 218‒22.
National Osteoporosis Foundation. NOF Scientic Statement. Available from: www.npf. Org/prevention/calcium and Vit-amin D. htm. [accessed 2010 August 16].
Bischoff-Ferrari H. Vitamin D: what is an adequate vitamin D level and how much supplementation is necessary? Best Pract Res Clin Rheumatol 2009; 23(6): 789‒95.
Bruyere O, Varela AR, Adami S, Detilleux J, Rabenda V, Hiligsmann M, et al. Loss of hip bone mineral density over time is associated with spine and hip fracture incidence in os-teoporotic postmenopausal women. Eur J Epidemiol 2009; 24(11): 707‒12.
Eugene V, Mc C, John AK, Anders O. A meta-analisis of the as-socation between fals and hip fracture risk. In: Abstracts of the IOF World Congress on Osteoporosis & 10th European Congress on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. May 5-8, 2010. Florence, Italy. Osteopo-ros Int 2010; 21 Suppl 1: S1‒399.
Rozental TD, Herder LM, Walley KC, Zurakowski D, Coyle K, et al. 25-Hydroxyvitamin-D and Bone Turnover Marker Levels in Patients with Distal Radial Fracture. J Bone Joint Surg Am 2015; 97(20): 1685‒93.
Bahlous A, Farjallah N, Bouzid K, Klouz A, Mohsni A, Sahli H, et al. Hypovitaminosis D in Tunisian osteoporotic postmeno-pausal women and therelationship with bone fractures. Tunis Med 2009; 87(3): 188‒90.
Dretakis K, Igoumenou VG. The role of parathyroid hor-mone (PTH) and vitamin D in falls and hip fracture type. Ag-ing Clin Exp Res 2019; doi: 10.1007/s40520-019-01132-7. (In Press)
Marco DM, Carlotta C, Roberto DM. Vitamin D depletion and risk of concomitant fractures at the upper limb in hip fracture women. Osteoporos Int 2013; 24(Suppl 1): S87‒S384.
Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B, Orav JE, Li R, Spiegelman D, et al. Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J Bone Miner Res 2009; 24(5): 935‒42.